title: Determinants of access to fertility preservation in women with breast cancer.
abstract: OBJECTIVE
  To evaluate socioeconomic, demographic, and medical factors that influence the referral pattern-either before cancer treatment for fertility preservation (FP, early referral) or post-chemotherapy for assisted reproductive technology (PCART, delayed referral)-in women with breast cancer.
  
  
  METHODS
  Secondary analysis.
  
  
  METHODS
  Academic medical centers.
  
  
  METHODS
  Three hundred fourteen patients with breast cancer who were counseled for FP (n=218) or PCART (n=96) from June 1999 to July 2009.
  
  
  METHODS
  None.
  
  
  METHODS
  Factors favoring early referrals.
  
  
  RESULTS
  Mean age at diagnosis was higher in FP vs. PCART (35.3±4.5 years vs. 33.9±4.7 years). Ninety percent presented with cancer stage 1 or 2. From 2000 to 2009 the proportion of referrals for FP increased continually. In 2009, nearly all (95.5%) were for FP. The majority (63.8%) was referred from an academic center. Patients with a family history of breast cancer were more likely to consult for FP (75.2% vs. 64.3% without). There was no association with occupation, income, race, ethnicity, obstetric history, and prior infertility treatment. Only 22.9% of those counseled in PCART, compared with 45.0% in the FP group, proceeded with a procedure.
  
  
  CONCLUSIONS
  There has been an increasing trend within the last 10 years for early referral of breast cancer patients to FP. Factors favoring early referrals are older age, early-stage cancer, family history of breast cancer, and academic center involvement. Those seen before cancer treatment are more likely to receive an intervention.
authors.affiliation: Institute for Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York 10595, USA.
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Lee
authors.forename: Elke
authors.initials: E
authors.lastname: Heytens
authors.forename: Fred
authors.initials: F
authors.lastname: Moy
authors.forename: Sinan
authors.initials: S
authors.lastname: Ozkavukcu
authors.forename: Kutluk
authors.initials: K
authors.lastname: Oktay
mesh_terms: D000328:Adult; D000465:Algorithms; D001943:Breast Neoplasms / Q000453:epidemiology / Q000628:therapy*; D002277:Carcinoma / Q000453:epidemiology / Q000628:therapy*; D015984:Causality; D005260:Female; D005298:Fertility / Q000502:physiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007247:Infertility, Female / Q000517:prevention & control*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011309:Preservation, Biological / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult